Students feel free to speak – unless they’re training to be doctors

But before the sector spends the next six months reviewing governing documents and resourcing free speech functions, it’s worth thinking about what the regulator’s own data says about the size and shape of the problem the conditions are supposed to fix.

Since 2023 the National Student Survey has asked final-year undergraduates in England “During your studies, how free did you feel to express your ideas, opinions, and beliefs?” In the 2026 results, 89.8 per cent of full-time undergraduates answered positively.

That makes it the fourth most positive of the 27 questions in the survey – behind only whether teaching staff are good at explaining things (93.7), library resources (90.6) and whether staff supported students’ learning (90.0).

Treat it as a category in its own right, as OfS does, and it beats every one of the multi-question themes – academic support (89.4), learning resources (88.9), teaching (88.1), learning opportunities (86.1), assessment and feedback (82.8), organisation and management (81.2) and, at the bottom, student voice (81.0). Students in England feel freer to express their opinions than they feel well taught.

And it has risen every year – 85.9 in 2023, 86.4, 88.4, and now 89.8. Whatever else has been going on in universities in the period in which a regulator was fining one of them £585,000, students have been feeling steadily freer to say what they think.

Where the problem actually is

There is a problem, though, and the data tells us where it is. Rank every subject area in England on the question and medicine and dentistry sits at the bottom on 80.7 per cent – six and a half points below the next lowest, pharmacy on 87.2, with politics, psychology and law clustered just above that.

More striking is that medicine is the only subject in the whole list where free expression scores lower than the average of the other 26 questions. Everywhere else – including politics, law and sociology, the disciplines the free speech debate is usually about – students rate their freedom to speak higher than they rate their teaching, assessment and organisation, by anywhere between 2.5 and 11.5 points. Medics rate it lower.

Look at university subject areas with 50 or more responses and 19 of the 50 lowest scores in the country are medicine and dentistry programmes. Kent’s new medical school is on 53.6 per cent, City St George’s on 64.0, Buckingham on 69.5, Manchester on 75.1, King’s College London on 76.3. Once you control for how those same students rate everything else about their course, medicine carries a penalty of more than six percentage points on this one question that no other subject comes close to.

Nursing (88.5), allied health (88.4) and health and social care (92.0) are all fine – so it isn’t placements, or the NHS, as such. It is medical school.

Strip medicine and dentistry out of the national figure entirely and free expression nudges from 89.8 to 90.0 and stays fourth. Medics are 2.7 per cent of responses – a real problem for them, a rounding error for the sector.

What might be going on

Let’s speculate, shall we? Medical students are subject from their first week to fitness to practise regimes and professionalism codes derived from General Medical Council guidance.

They are assessed, and signed off, by the consultants and clinical supervisors whose judgements they might want to question. The curriculum is more normative than most – there are right answers on clinical practice, safeguarding and public health, and disagreeing with them can be reframed as a professionalism concern rather than an intellectual position.

Medical cohorts are also on longer courses, more international and more ethnically diverse than average, and a sense of belonging tends to travel with a sense of being free to speak.

There’s a clue in the data too. Within health subjects, the free expression score moves almost in lockstep with whether students feel their opinions are valued by staff – a correlation of 0.70, against 0.50 in other subjects – and with whether feedback is acted on (0.63 against 0.39) and how well the SU represents them (0.45 against 0.19).

Outside health, feeling free to speak is a loose, general item. Inside it, it is about power and being listened to.

Seating plans and ward rounds

Now sit that in the context of the draft guidance on the duty to “promote” freedom of speech. Its suggestions run to seating students in small groups around tables rather than in lecture-theatre rows, smaller moderated seminars, unrecorded Q&A sessions, staff declaring the classroom a “safe space” for ideas, and governing bodies adopting a position of institutional neutrality.

None of that goes anywhere near a fourth-year on a ward round who has just watched a consultant do something she thinks is wrong, and who knows the same consultant is filling in her assessment.

None of it touches fitness to practise, the professional regulator’s standards, or the culture of the trust whose premises she’s standing on – none of which the university can fix with a seating plan.

The guidance is written for the tutorial at Cambridge that the culture war imagines, not the clinical placement where the data says the problem is.

The dog that didn’t bark

All of which raises the question of Arif Ahmed. OfS’s director for freedom of speech and academic freedom has had plenty to say about foreign influence, institutional neutrality, equality policies and the treatment of gender critical academics. It is hard to find him raging about medical schools.

There has been no summit with the Medical Schools Council, no letter to the GMC, no meeting with the BMA’s medical students committee or the Department of Health and Social Care about why so many of the country’s lowest-scoring subject areas on free expression are training doctors.

That is odd for a regulator that describes itself as risk-based, and odder still for one that runs the survey the data comes from. OfS put the question into the NSS. It publishes the results every summer. Its promote guidance cites its own research into students’ free expression.

If it were reading the data it holds, the first phone call after Sussex would have been to the medics, not to the EDI director.

Never really about risk

If the approach to free speech regulation had ever been about finding where students actually feel least free to speak and doing something about it, the enforcement history of the last three years would look very different – scrutiny of professionalism codes, guidance for clinical supervisors, a conversation with the professional regulators.

Instead we got a trans and non-binary equality policy statement, a £585,000 fine and a flowchart.

The pattern is consistent with a regulatory agenda assembled from the Telegraph’s comment pages rather than the regulator’s own dataset – one where the problem was defined in advance as a particular set of policies in a particular set of departments, and where the evidence was never going to be allowed to redirect it.

The students who most need someone to promote their freedom to speak are being ignored. The regulator has had four years of data telling it so. It has been looking the other way.